Overview
Ok I'll try make this as short as possible. I have severe anhedonia both for seeking rewards and from receiving pleasure when goals are accomplished. This, I'm assuming, ties into my complete lack of sexual desire, poor sexual performance, etc. Additionally, I have cognitive issues with memory, attention, etc. Lastly, I also have some low grade, susceptibility to pain (Fibromyalgia type symptoms?) Additionally I have some Social Phobia that preceded the above problems by about 12 months, but has worsened.
This developed over the course of the last 2.5 years (I'm 23) and has so far been somewhat resistant to treatment. Right now I'm taking Rx'd Dextroamphetamine 2-4 days per week just to get me functioning semi-normally. I realize this is a band-aid approach and will stop treatment with Dex in the next week or two when I'm done studying for the year.
Potential causes
Prolonged Stress
- I went through a heavy bout of depression about 2 years ago, that no doubt left me with some neurological damage. I am not in a saddened state anymore necessarily, but I'm stuck in a state of emotional flatness.
- My thinking is this could have someone led to atrophy of my Hippocampus, or some other stress induced neurological change.
- Some AD's have been tried. Will discuss shortly.
Drug Abuse/Misuse
- I have experimented with a variety of drugs recreationally and medicinally. None really in "excess" but definitely irresponsible use
- Some of the drugs I used that coincided with developemnt of my current state include: Methamphetamine, Oxycodone, MDMA, Dextroamphetamine (therapautic and above doses), DXM, Marijuana, Psychedelics (these actually helped me out of the darkness at times, even after the drug wore off)
- Again, I must reiterate that I wasn't addicted to any of these drugs and never went on bendors, but definitely may have damaged my reward pathways. I have also been through periods of sustained abstinence from all these drugs with little relief from symptoms
Treatments Tried
Tianeptine
- Positives: Improved anhedonia to an extent, mood improved greatly, instant pleasure, increased sociability, slightly increase libido, eradicated anxiety (remained somewhat after cessation)
- Negatives: Laziness, addictive, rebound depression upon withdrawal (Mu agonist)
Bupropion
- Positives: More energy and motivation (not significantly)
- Negatives: Anxiety at times, dry mouth, memory concerns (anticholinergic)
Deprenyl (selegiline)
- Positives: Some improvement in anhedonia, more sociable, slightly improved libido
- Negatives: Lethargy, too many interactions, possible withdrawal symptoms (MAO-B upregulation?)
5htp
- Positives: Less prone to worrying about my problems
- Negatives: Worsens anhedonia and libido
Dextroamphetamine
- Positives: Increased motivation, reduces anhedonia, improves cognition, improves sociability
- Negatives: Tolerance to most benefits, Increases anhedonia overtime, can overflow stimulation into anxiety, hair loss, withdrawal symptoms, neurological impairments long-term
Memantine
- Increase Generalised anxiety, ruined sleep, ruined cognition
Choline (ALCAR, CDP Choline, Alpha GPC)
- Induces depression, destroys motivation
Piracetam
- Positives: Improved anhedonia in some aspects, pleasure obtained from music
- Negatives: Sometimes increased social anxiety, made libido worse at times as well
Note: There are a range of other things i have tried that probably aren't even worth mentioning.
Where to from here?
Well I think I have damaged my reward pathways through dopaminergic, and opioid drug misuse, especially during times of chronic stress. From my own reading and research I'm beginning to believe I may have upregulated Kappa Opiod receptors in the mesolimbic system (VTA, NAcc) due to my weird acquired fear response in social situations that began sometime around my abuse of oxycodone and recreational amphetamine use. Add this with the down-regulation of DA recpetors in the same reward pathways and I believe I might be in the right vicinity.
I'm not interested in taking drugs that will further impair this system in the long-term. That is another reason I wouldn't be willing to give conventional treatments, like Bupropion an extended trial. I believe I'm probably far beyond most conventional treatments if I want sustained remission, and thus I have come up with a couple possible treatment avenues.
Naltrexone
- Should help repair damage done in the reward pathways in relation to opioid receptors, and DA receptors to a lesser extent. Has research backing it's ability to improve sexual function in males.
- I'm concerned over how long treatment must be sustained for though. Anyone with any idea how long LDN (Low Dose Naltrexone) therapy must be used for to gain long-term benefits upon cessation?
- Ordered some the today and will update after trial.
Ibogaine
- I live in Australia and have been in contact with an experienced Ibogaine treatment physician(?)
- Work on a similar hypothesis as my LDN approach, except in a more acute, spiritual sense I guess.
- Would be financially intrusive for myself though
Agomelantine
- I'm actually surprise this drug hasn't got more attention on these boards. I haven't tried it myself but am very intrigued by what I have read.
- Anecdotally, improves libido, and the literature claims it's an effective AD, acting on DA in some parts of the mesolimbic system, without directly manipulating dopamine (5ht2c antagonism), thus could theoretically be absent of downregulating this system further.
- Prohibitively expensive though.
Any help or advice would be appreciated. I'm probably leaving out parts, but as is my current state, typing this post alone has left me drained.
Thanks guys